Augmented and virtual reality simulator for professional and educational training

ABSTRACT

A method and apparatus for an augmented reality simulator for professional and educational training is provided. The simulator provides a training environment spanning one or more physical locations in which one or more virtual avatars representing purely virtual objects or persons or real physical objects or persons which are located at a different physical location are projected into the physical space. The avatars are interactive with other avatars and real objects or persons and update over time or in response to actions taken by other real or virtual elements, or based on predefined instructions. Sensors and devices are used to detect the locations of and actions taken by real persons or real objects and this sensed data is used to evolve the state of the simulation and avatars based on predefined instructions and programs and update the view of all participants.

CROSS-REFERENCE TO RELATED APPLICATIONS; BENEFIT CLAIM

This application is a continuation of International Application No.PCT/US2015/049021, filed Sep. 8, 2015, which claims the benefit ofProvisional Appln. No. 62/047,589, filed Sep. 8, 2014, the entirecontents for both of which are hereby incorporated by reference as iffully set forth herein.

FIELD OF THE DISCLOSURE

The present disclosure relates to computer-based training utilizingsimulation, and more specifically to augmented reality simulationsoftware for professional and educational training purposes, includingbut not limited to medical and mechanical training.

BACKGROUND

The concept of simulation of critical events to hone skills, in contrastto mere practice, has long been a staple of human training methodology.At its heart, the goal of simulation is to truly mimic the physical andpsychological experience of an event, thus harnessing the power ofemotional context and psychological stress to retain both physical andintellectual skills and lessons with more reliability than practicealone can yield.

Various industries have adopted and refined simulation-based trainingmethodologies, attempting to replicate work environments as preciselyand accurately as possible to prepare students and professionals forcritical events that may be encountered in practice. In the aviationindustry, for example, flight simulators have improved over time ascomputer technology has become more advanced and affordable. In theinstitution of medicine, medical scenario simulation has grown to becomea standard component of medical training and continuing education,typically relying on physical “dummy” apparatuses to represent the“patients” or “subjects” of the simulation.

Simulation-based training systems that are both low cost and completelyimmersive are significantly limited or non-existent in many industries.Further, current simulation tools are not tightly integrated withcomputer systems that allow for simulation case scenarios to be authoredfor distribution and reuse, or stored and aggregated for analysis,scoring, and review. With regard to medicine specifically, the majorityof simulation taking place in medical education today involves the useof full-scale, computer-driven manikins that are capable of portrayinghuman physiology and around which a realistic clinical environment canbe recreated. In this sense, manikin simulators are uniquely suited fortraining scenarios capable of satisfying the requirements for equipmentfidelity, environment fidelity, and psychological fidelity, or thecapacity to evoke emotions in trainees that they could expect toexperience in actual practice. However, there remains a gap in themanikin's ability to represent a broad array of demographics or visuallyimportant clinical scenarios. In addition, there are significantlogistical challenges associated with gathering work-hour limitedtrainees at sufficiently frequent intervals to foster maintenance ofclinical competency using manikin simulation. Instructor salaries,technician salaries, and opportunity-costs involved in equipping andmaintaining a state-of-the-art simulation facility employing suchmanikins represents a significant cost and places significantlimitations on the ability of manikin simulation to integrate fully intoexisting curricula.

Beyond the training of novice medical staff, simulation-based traininghas also come to be recognized as integral to maintaining skills offully licensed and practicing medical staff, but the logisticalchallenges of bringing staff together outside of regularly scheduledhours to a high fidelity environment or of bringing a high fidelityenvironment to the regular work location of the staff has presented analmost insurmountable challenge to simulation-based training in thispopulation. The cost and lack of portability of the modern high fidelitymedical simulation system also presents a barrier to its wider adoptionoutside of medical education institutions and outside of wealthynations, despite the clear need for such maintenance training withincommunity institutions and novice and maintenance training in developingcountries. The limited ability of manikin based systems to representdifferent ethnicities, age groups, and visual symptoms, includingrashes, also represents a degradation of psychological fidelity, withthese aspects of medical simulation particularly relevant to training ofexperienced providers and in the field of tropical medicine.

The approaches described in this section are approaches that could bepursued, but not necessarily approaches that have been previouslyconceived or pursued. Therefore, unless otherwise indicated, it shouldnot be assumed that any of the approaches described in this sectionqualify as prior art merely by virtue of their inclusion in thissection.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the present invention described below withdetailed descriptions and accompanying drawings. Embodiments of theinvention have been described with reference to numerous specificdetails that may vary from implementation to implementation. Thespecification and drawings are, accordingly, to be regarded in anillustrative rather than a restrictive sense. The sole and exclusiveindicator of the scope of the invention, and what is intended by theapplicants to be the scope of the invention, is the literal andequivalent scope of the set of claims that issue from this application,in the specific form in which such claims issue, including anysubsequent correction.

FIG. 1 is a diagram illustrating the use of a shared augmented realityenvironment for medical training over multiple geographic locations;

FIG. 2 is a diagram illustrating the use of an augmented realityenvironment for automotive training;

FIG. 3 is a diagram illustrating the use of a shared augmented realityenvironment for training over multiple geographic locations and thecommunications between those locations;

FIG. 4 is a diagram illustrating the use of a shared augmented realityenvironment for training using a physical dummy as a point of referenceto anchor the augmented reality environment;

FIG. 5 is a diagram illustrating the use of an augmented realityenvironment for training, a series of computing devices used to createthe environment, and an instruction file specifying the trainingaugmented reality environment;

FIG. 6 is a diagram illustrating the use of one or more network computersystems for retrieval of stored instruction files for augmented realityenvironments, with optional use of a marketplace for instruction files;

FIG. 7 is a diagram illustrating the use of software for the authoringof instruction files for augmented reality environments;

FIG. 8 is a diagram illustrating the use of software for the authoringof instruction files for a subcomponent tool for an augmented realityenvironment; and

FIG. 9 is a diagram illustrating the use of one or more special-purposecomputing devices.

DETAILED DESCRIPTION

In the following description, for the purposes of explanation, numerousspecific details are set forth in order to provide a thoroughunderstanding of the present invention. It will be apparent, however,that the present invention may be practiced without these specificdetails. In other instances, well-known structures and devices are shownin block diagram form in order to avoid unnecessarily obscuring thepresent invention.

Techniques are described herein that provide for systems, methods, andnon-transitory computer-readable media for simulation based training.This methodology uses augmented reality, a particular incarnation ofvirtual reality, in order to greatly advance the degree of equipmentfidelity, environment fidelity, and psychological fidelity available insimulation for training, with certain embodiments also decreasing thecost and improving portability of simulation systems, depending on theparticular hardware utilized to realize the simulation system.

Here, an augmented reality environment refers to the perception of auser of their real, physical environment with the addition of virtual,projected, two or three dimensional objects in that environment.Integral to the concept of an augmented reality environment is thefeature of the virtual objects to be perceived to exist in the realspace as if they were real objects, with the ability of users to walkaround them and see them from different angles, as appropriate. Inharnessing this for training, the method described enables a replicationof nearly an infinite number of environments.

In some embodiments, processes are described herein for establishing anaugmented reality environment, utilizing a computer application toauthor simulation scenario cases, processing actions on virtual objects,and recording the events transpiring while users are immersed in theaugmented reality environment. Such scenario cases may be comprised ofinstruction sets and associated metadata and subordinate instructionsets and data, such as audio data or image data, and may be distributedlocally or broadly through the use of an internet infrastructure,marketplace, or other distribution mechanism.

Establishing an augmented reality environment within a real space refersto using computer generated virtual models, or virtual avatars,projected into the space, where the avatars behave as if they arephysically in the space, and where multiple users can see each other, orat least placeholders of each other, and the avatars, and interact withthe avatars and each other, mimicking a situation where all avatars andusers are physically in the real space and are solid objects or beings,even in the scenario where the user themselves are not in the same realspace. Virtual avatars may be projected into empty physical locations orthey may be projected over existing real objects and partially or fullyobstruct the actual view of the real object while allowing for physicalinteractions, such as touch, with the real object, and allowing for suchinteractions to be detected and the virtual avatar updated based on theinteraction.

Utilizing a computer application to author scenario cases refers to theuse of an authoring application which outputs an instruction set thatdefines the appearance, properties, and behavior of virtual avatars inan augmented reality environment with respect to time, as well asdefining virtual avatars' effects on other objects in the augmentedreality and the effect of other objects on the virtual avatar.

Processing the actions on virtual objects in an augmented realityenvironment refers to the method of matching virtual versions of realobjects to the real objects in the augmented reality environment usingsensors, where the virtual object occupies the same space as the realobject, and using the actions and interactions between these virtualobjects to accurately change the appearance or other properties of thevirtual objects as defined by their pre-programmed properties. This alsorefers to the method of changing the appearance or properties of purelyvirtual objects, with no physical analog in the real environment, basedupon actions and interactions with other purely virtual objects or realobjects, as defined by their pre-programmed properties. This couldinclude purely visual changes, movements, or other properties such asaudio vocalizations. Detection of actions and interactions may involvethe use of wearable or freestanding sensors, such as cameras, IRbeacons, wireless beacons, and inertial measurement units. Some sensorsmay be attached to augmented reality devices worn by participants, orthey may be attached to real objects and communicate with the system toprovide additional information about the state of the real and virtualspace relative to those objects, or they may be freestanding.

Recording the events transpiring in an augmented reality environmentrefers to a method of detecting and recording user actions such as bodymovement, and speech in addition to the passage of time, the visual oraudio experience of participants, and the occurrence of pre-programmedevents, and using that record to evaluate user performance based up onpre-determined metrics.

FIG. 1 shows one possible embodiment of using a shared augmented realityenvironment for training, in which a plurality of real participants andreal objects are located in distinct geographic spaces, with the sharedaugmented reality environment populated by virtual avatars of livingbeings and inanimate objects. Specifically, the figure shown representsthe use of the shared augmented reality environment for medical trainingin two locations, depicted here utilizing four panels, showing onemedical training session occurring simultaneously (or nearsimultaneously due to potential lag caused by network and/or differentprocessing speeds of devices) at two different physical locations 101and 102. The figure shown depicts the real physical spaces in locations101 and 102 in the top two panels, populated only by real physicalobjects and living beings. The bottom two panels of the figure depictthe augmented reality environment, populated by real physical objectsand living beings as well as virtual avatars of objects and beings. Thefigure depicts location 101 on the left half of the figure and location102 on the right half of the figure.

According to this particular embodiment, three human participantsincluding a physician 103, a nurse 104, and a respiratory therapist 105,are participating in a medical training session concurrently.Participants 103 and 104 are located in one particular physical location101 depicted in the scene, and participant 105 is located in a differentphysical location 102 depicted in the scene.

The physician 103 is wearing an augmented reality device 106, which is adevice that has the capability to display to the surrounding physicalspace with virtual elements projected into the space which appear to bephysically present within that space, immersing the wearer in theaugmented reality environment, and which also, in this embodiment, hasfurther capabilities built into the device or attached to the device ina modular fashion. Specifically, the embodiment shown includes internetcommunication, sensors, including multiple cameras, IR tracking devices,inertial measurement units, and other sensors, audio speaker systems,and headphones. Further, one embodiment of device 106 may include thecapability of binocular vision to further immerse the participant in theaugmented reality environment.

The physician's augmented reality device 106 is projecting three virtualavatars 107, 108, and 109, which are computer generated virtualrepresentations of living beings which are not physically present, butwhich are projected into the physical view of the individual wearing anaugmented reality device so as to appear to be physically present, whichmay be animated and interactive with the physical participants and withother virtual avatars, and which may experience changes of state duringthe course of use of the system.

The virtual avatar 108 is the representation of human participant nurse105, who is not physically present in the physical location 101 wherephysician 103 is located, but who is instead using the system in adifferent location 102 and is being physically projected into physician103's field of view by the augmented reality device 106 in a positionand orientation relative to the marker 192 affixed to bed 111 inlocation 101 that corresponds to participant 105's position andorientation in location 102 relative to the marker 193 affixed to bed112. In this embodiment, markers 192 and 193 are visibly distinctpatterns, quick response codes. When the marker is read by thesimulation system, the marker pattern, or in other embodiments the otherunique qualities about the marker, are compared to a pre-programmed setof markers for that simulation session. Once the matching marker isfound in the reference set, the data for the avatar programmed to beprojected over that marker is retrieved and used to project the avatarin three dimensions over the marker. The appropriate position andorientation of the avatar is calculated by the system in part using thesensor data provided by participant 105's augmented reality device 110as well as participant 103's augmented reality device 106 based on theposition and orientation of the marker. The system uses this sensor datato compute the appropriate angles based on the relative position andorientation of the participants in the session to that of an anchorobject such as markers 192 and 193 affixed to beds 111 and 112,respectively. Avatar 108 may appear as an exact three dimensionalreplica of participant 105, or a generic human avatar that occupies thesame relative position as participant 105, or a different placeholdergraphical avatar located in the same relative position.

Alternatively, this position and orientation may be computed based onrelative positioning and orientation to any other physical object ormarker in the scene, where a marker is a pre-planned physical object,visual or physical pattern, or electromagnetic emitter used as afiduciary point by the system to perform relative position andorientation calculations, or the position and orientation may becomputed using a different methodology, such as simultaneouslocalization and mapping, as needed. An example of a physical pattern, aflat wall, is shown with virtual marker 194, which represents theplacement of a location anchor, the virtual marker 194, within theaugmented reality environment based upon pattern recognition of a flatsurface, where the two-dimensional virtual avatar, cardiac monitorscreen 124, is located relative to virtual marker 194. An example of anelectromagnetic marker, a marker embedded into ultrasound probe 126, isalso shown, where such an electromagnetic marker may communicatelocation, orientation, and identity data, similar to the visual markers192 and 193. In this case, the marker also allows for the registrationof the real US probe 126 with its virtual avatar 127. In the case of anelectromagnetic marker, detailed identity data about the real object towhich it is attached, including data regarding how the real objectinteracts with virtual objects, and data regarding how the virtualobject to which it is registered, in this case virtual ultrasound probe127, should appear and interact may be actively transmitted. In the caseof a passive electromagnetic marker that acts similarly to a visualmarker, with simulation system sensors only able to read location,orientation, and identity data, the system would use identity data, suchas a code being broadcast by the marker, to properly register thecorrect virtual avatar to the real object. By comparing that identitydata sensed to a pre-programmed set of identifiers, the simulationsystem determines which particular avatar, with its correspondingproperties, is to be projected to overlay the marker, in this caseavatar 127. Once the virtual avatar is registered to the physicalobject, the system projects the avatar over the marker aspre-programmed, typically occupying the identical space as the realobject and following the movement of the real object in the augmentedreality space exactly. Thus, when real object 126 is registered andinteracts with virtual objects, such as avatar 107, the simulationsystem uses pre-programmed instructions to determine the result of theinteraction. For instance, placing real object 126 in contact of thechest of avatar 107 in the augmented reality space would also placevirtual object 127 in contact with the chest of avatar 107, which can bedetected by the system as a collision, and which can trigger the displayof US result image 122 on device 121. This collision is also recorded bythe system, and if listed as a performance metric, the use of probe 126by participants may contribute to their performance score. In oneembodiment, not depicted in the figure explicitly, additional sensors,such as cameras not attached to any participants, or three-dimensionallocation systems may also be used to calculate positions andorientations of visual or electromagnetic markers.

As indicated above, actions of participants, avatars, and/or otherobjects within the augmented reality environment may be monitored andrecorded. Such monitoring may be useful in the context of evaluating theperformance of one or more participants that are engaged in a trainingsimulation. Using at least one sensor, such as a microphone, camera,etc., an augmented reality device may detect an occurrence of an actionwithin the augmented reality space. The action that is detected may varyfrom implementation and may include, without limitation, a physicalmovement of a participant, a vocalization by a participant, aninteraction between a participant and a virtual avatar, an interactionbetween two different virtual avatars, an interaction between a physicalobject and a virtual avatar, an interaction between a participant and aphysical object, or some combination thereof. Once detected, theoccurrence of the action may be recorded to volatile or non-volatilestorage of a computing device. The data used to record the action mayvary and may include without limitation, text data describing theaction, a visual image of the action, a transcription of a vocalization,or some combination thereof. During the simulation or at the end of thesimulation, the recorded action may be compared to a performance metric.In some embodiments, the performance metric identifies a set of goalaction, where the goal actions specify the actions a participant shouldtake or, in some instances, the actions a participant should not take,during the simulation. There may be grades or weights associated withthe different goal actions. For instance, if a participants takes thebest course of action, the participant may receive the highestperformance score for that action whereas a different action may be anappropriate action, but not the best, where the participant earns alower performance score for this action, and the lowest performancescore if no appropriate action was taken. The system may thus comparerecords of the action to the performance metric to perform an evaluationof the performance of one or more participants. The system thengenerates a performance evaluation that includes one or more measuresthat indicate the performance of the one or more participants in theaugmented reality environment. A measure may be a score, grade, or someother quantitative or qualitative indicator of a participantsperformance, the calculation of which may vary from implementation toimplementation and may depend on the performance metric used and theactions recorded during the simulation. In the context of a medicalsimulation, the system may monitor whether a participant ordersmedication, whether the dosage used/applied is correct, whether theparticipant performs a surgical procedure on a virtual avatar correctly,response times between events and actions, etc. to evaluate theperformance of the participant. The evaluation report may be printed,stored, and/or transmitted over a network to notify the participantand/or a moderator of the simulation result.

The virtual avatar 108 mimics the physical actions performed byparticipant 105 in location 102. In this scene, participant 105 is usingtool 113, a bag-valve-mask. The bag-valve-mask is projected virtuallyinto the space 101 as virtual tool 114 using the system. The use of tool113 is detected by augmented reality device 110 by means of the sensorson the device 110 and the physical configuration of tool 113, oralternatively by the use of a fiduciary marker placed upon tool 113, orby some other marking technique as previously described. The systemdetects the use of tool 113 by participant 105 and projects virtual tool114 with avatar 108 so that her actions in location 102 are seen by theother participants, mimicking a situation in which participant 105 isusing tool 113 in the same physical space 101 as participants 103 and104. The virtual avatar 129 similarly mimics the physical actionsperformed by participant 104 in location 101. In this case, emitter 197provides additional location data regarding the location of participant104's wrist, allowing her body movements to be detected with higherprecision and avatar 129 to more accurately mirror her body movements.

In this embodiment, the augmented reality medical training session inwhich the three real individuals 103, 104, and 105 are participating hasbeen designed and created using an authoring application whose outputwas a file containing the information necessary to project the virtualavatars present in in the shared augmented reality environment. Thisoutput file contains an instruction set that describe the physicalproperties of the virtual avatars, including their appearance, as wellas different sets of properties unique to each different avatar.

In the figure, avatars 107 and 109 in location 101 represent humanbeings, where the instruction set within the file contains data for thedevices 106, 110, and 190 to project those avatars. Further, as avatars107 and 109 do represent human beings, the instructions describing themalso provide information regarding their physiology and behavior, howthat physiology and behavior vary over time as the instructions areexecuted, and how their physiology, behavior, and appearance may changein response to different interactions with real objects, virtualavatars, and virtual interventions, such as medication administration.Avatar 114 in location 101 represents a tool, and the instruction setalso contains data on the appearance and properties of this tool,including how its use affects other virtual avatars.

The computing device 199 and the router 198 in location 101 act as ahost and conduit for network communications, respectively, allowing thecoordinated projection of all of the avatars in the augmented realityenvironment. In this case, the computing device 199 is running asimulation execution application which can execute the previouslymentioned instruction set to build the augmented reality environment.Computing device 199 communicates wirelessly, in this case, with clientdevices 106, 110, and 190, as well as the emitters contained withinobjects 118, 126, and 191, either directly or via routers 198 and 195.

As the host, computer device 199 receives location data and propertydata on all markers from sensing devices, and then rebroadcasts thatdata to all projection devices in order to allow for a coordinated andsimultaneous (or near simultaneous) view of all avatars and to changethe augmented reality environment appropriately in response to avatarinteractions. In this way, all three dimensional avatars correctlyoccupy the three dimensional augmented reality space for allparticipants, such that when viewed from different angles and positionsthe avatars occupy a consistently same space in a consistently sameorientation as if they were physically present. Given sufficientcomputing power, device 106 or 190 may also function as the host. In thecontext of internet access via routers 198 and 195, devices 199, 106,110, and 190 may also download data as needed from a remote server inaddition to accessing local databases in order to project all theavatars populating the shared augmented reality environment over thecourse of a simulation session.

Host device 199 may also be used by any participant to enter commandsduring the execution of an instruction set that change the augmentedreality environment, for instance creating a new avatar or triggering achange in physiology in a human avatar. Control of the simulationenvironment using the host device 199 running the simulation executionapplication also includes navigation of the instruction set describingthe augmented reality environment, so that if a participant must leavethe simulation environment, wishes to re-experience a specific event, orwishes to skip ahead to a later time point, execution of the instructionset can be appropriately navigated.

The virtual avatar 109 represents a virtual character that does notrepresent a physical human participant. This character is generatedentirely by the system, and can interact with the human participants aswell as other virtual avatars. Avatar 109 is projected into thephysician 103's view by device 106 and appears to be in the samephysical space 101 as physician 103. The same virtual character isprojected into physical space 102 by augmented reality device 110 andseen by nurse 105 as avatar 115. Avatars 115 and 109 are bothrepresentations of the same system generated virtual character, and areprojected similarly in both locations 101 and 102. The actions andinteractions of this character are projected into the view of all of theparticipants in the simulation and dictated by the instruction set beingexecuted by device 199.

The virtual avatar 107 also represents a virtual character that does notrepresent a physical human participant. In this scene, avatar 107represents a patient, who is also represented in location 102 as avatar116. Avatar 107 is projected to appear on top of physical bed 111 andavatar 116 is projected to appear on top of physical bed 112 in order toprovide a realistic patient setting for the purpose of the representedmedical training session. The virtual patient is fully simulated by thesystem and is interactive with other participants as well as virtualavatars based upon the instruction set being executed by device 199. Thephysiological and physical state of the virtual patient is calculatedand simulated by the system based on accepted physiological parametersas well as the pre-programmed parameters of the associated trainingscenario. The simulated parameters may include breathing and respiratoryrate, heart rate, oxygen saturation, auscultated sounds, ultrasoundimages and other imaging modalities, physical signs and stigmata, andother physiologic parameters as appropriate. The simulated patient mayalso converse with other participants and avatars or communicate inother verbal or nonverbal means. Using a sensor, the system may detectvocalization by the participants as well the content of thosevocalizations, which may comprise a command to the system, for instanceto administer a medication, or an interaction with a virtual avatar,such as a question about the virtual patient's medical history. Thesimulated state of the patient may evolve over time or due to eventssuch as actions taken by other virtual avatars or physical participants.

The virtual patient avatar 107 can be interacted with directly usingbody parts of the participant or using tools, either virtual, such astool 117, or physical, such as tools 118, 113, and 126. Physical toolsthat are present in only one location such as 113, 118, and 126, can beprojected into another, as are virtual tools 114, 128, and 127respectively. The results of tool use can be projected onto a realscreen such as results 120 on screen 119, or they can be projected ontoa virtual screen, such as virtual results 124 on virtual screen 123. Inthis case, results 120 and 124 represent the same results, which areprojected simultaneously and identically in both locations 101 and 102,using real screen 119 and virtual screen 123, respectively. Results froma specialized tool such as ultrasound 126 that require a specializedmachine to display, such as machine 121, can be projected onto the realscreen as on machine 121, or a virtual machine can be projected into thespace if no real machine is present, as is virtual machine 125 inphysical location 102.

Results from the use of real or virtual tools upon virtual avatars arecomputed by the system. The use of tools is detected by the system usingappropriate sensors. In this scene, physician 103's use of stethoscopetool 118 is detected by his augmented reality device 106 by use of awireless beacon on device 118. Alternatively, this tool use could bedetected by use of sensors on device 106 such as a camera detecting afiduciary marker placed on tool 118 or the recognition of the physicalshape of tool 118. The fact that the tool 118 is currently interactingwith avatar 107 is detected by the system by means of correlating thevirtual simulated spatial position of avatar 107 and the physicallocation of tool 118 and the virtual tool 128 to which it is registered.The system then outputs the appropriate result in the appropriatemanner. In the case of stethoscope tool 118, which is placed over thesimulated tricuspid auscultatory area of patient 107, the appropriateheart sound is played by device 106 and heard seamlessly by participant103 in a manner similar to that if participant 103 was using his deviceupon a real physical human patient. In this scenario, the virtualpatient 107 also has chest wall tenderness, where placement of thestethoscope 118 upon his chest triggers the virtual patient 107 togroan, as per the instruction set being executed and controlling theaugmented reality environment.

The use of therapeutic tools, such as bag valve mask tool 113 issimilarly processed by the system. The system detects the use of thetool by an appropriate mechanism such as those discussed above. When thetool is used upon the patient, an appropriate physiological response iscalculated based on the current simulated physiological and physicalstate of the patient and the characteristics of the specific tool, whichmay be automatically assigned to virtual avatar of the tool based uponthe tool's identity, the patient's state is updated based on thiscalculation, and then the projection of the patient and anyphysiological or physical signs and results are updated accordingly. Inthis scenario, participant 105 uses tool 113, a bag-valve-mask, toprovide blow-by oxygen. In response to the presence of tool 113 nearvirtual patient 116's face, virtual patient 116 in location 102 hasslower breathing, which is mirrored simultaneously by virtual patient107 in location 101, with the breathing changes and improvedoxygenation, reflected by a higher oxygen saturation percentage,displayed simultaneously on virtual monitors 120 and 124.

In location 102, physical participant 105 sees a similar scene to thatseen by participant 103 in location 101 even though participant 105 isin a different physical location. This is effected by participant 105'saugmented reality device 110, which projects physical participants 103and 104 as virtual avatars 129, 130 respectively. Avatars 129 and 130are projected to appear in the same relative position to physical bed112 and marker 193 as physical participants 103 and 104 are relative tophysical bed 111 and marker 192. Alternatively, positioning could beaccomplished through a different mechanism, such as those describedabove. Additionally, virtual avatars 115 and 116 are projected intolocation 102 just as avatars 109 and 107 are projected into location 101respectively. Virtual screen 123, and virtual machine 125 are alsoprojected into location 102 in order to duplicate physical screen 119and physical machine 121 so that participant 105 is able to see all ofthe results seen by participants 103 and 104. This overall provides theappearance to participants 103, 104, and 105 that they are located inthe same room and interacting with the same patient 107 and virtualcharacter 109 even though in fact they are in two separate locations 101and 102. The participants are further able to interact as a team andperform their duties with the patient together seamlessly providing anintegrated training experience.

FIG. 2 shows one possible embodiment of using an augmented realityenvironment for training, in which a single real participant, mechanic201, uses the augmented reality environment for mechanical training in asingle location, with a virtual training apparatus, engine 202,projected virtually into the physical space using augmented realitydevice 203.

The mechanic 201 is wearing an augmented reality device 203. Theembodiment shown includes interne communication, sensors, includingmultiple cameras, IR tracking devices, inertial measurement units, andother sensors, audio speaker systems, and headphones in addition to theaugmented reality capability of the device.

The augmented reality device 203 is projecting virtual avatar 202, whichis a computer generated virtual representation of an engine which is notphysically present, but which is projected into the physical view ofmechanic 201 by augmented reality device 203 so as to appear to bephysically present, and which is animated and interactive with bothphysical participants and other virtual avatars, and which mayexperience changes of state during the course of use of the system.

In this embodiment, the augmented reality mechanical training session inwhich mechanic 201 is participating has been designed and created usingan authoring application whose output was a file containing theinformation necessary to project the virtual engine avatar 202 presentin the augmented reality environment as well as an instruction setdescribing the physical and interactive properties of the virtual engineavatar.

Avatar 202 represents a computer virtual representation of a simulatedengine, where the instruction set within the file contains data fordevice 203 to project the avatar 202 into the view of mechanic 201.Further, this instruction set also describes how the simulated engine isaffected by interactions with mechanic 201, such as mechanic 201's useof tool 204 to make a modification of the engine. This includes bothphysical instructions which will affect the visual appearance of avatar202 as well as instructions that describe how this modification willaffect the operation of the engine, which will update the internalrepresentation of the simulated engine, thus allowing for furthermodifications and operations to be performed upon the engine withcomposited effects, and which may allow the simulation environment topredict the performance characteristics of the modified engine forsimulated testing or for evaluation of mechanic 201's performance in thetraining session.

Tool 204 represents a physical tool being held by mechanic 201. Thesensors of augmented reality device 203 detect the use of tool 204 andits identity. In this embodiment, the camera of device 203 detects thephysical form of tool 204 and uses this information to determine theposition of tool 204 relative to the position of mechanic 201 and thevirtual simulated position of engine 202. In the figure, physical tool204 intersects with engine avatar 202 at point 205, which corresponds toa sub-component of virtual engine avatar 202. Using the sensedinformation from augmented reality device 203, the simulation systemdetects that mechanic 201 is attempting to interact with engine avatar202 using tool 204 at point 205, and using the file instructions,determines what effect the interaction performed by mechanic 201 willhave upon the simulated engine based upon the identity of tool 204 andthe tool properties contained within the instruction set or downloadedby the simulation application as prompted by the instruction set. Thesystem makes the appropriate modification to the simulated appearance ofengine 202, and this updated appearance is projected to mechanic 201 viaaugmented reality device 203. This provides the appearance to mechanic201 that the use of tool 204 is modifying avatar 202 just as it wouldmodify a real engine if used at the same point, providing the appearancethat mechanic 201 is interacting with a real engine. The modificationsmade by mechanic 201 are saved to the instruction set file and make themodifications persistent after they are complete.

After mechanic 201 is finished making modifications to avatar 202 usingtool 204, he may run a simulated test of the virtual engine. Thesimulation system then uses the saved modifications to calculate theappropriate performance of the modified engine using the fileinstructions and then projects an avatar of the engine in operation,allowing mechanic 201 to evaluate the changes that he has made.Alternatively, mechanic 201 may request an evaluation of his performancein the training scenario. The simulation system would compare themodifications made by mechanic 201 and the resulting performance topreset parameters contained in the instruction set file and then providea score and explanation to mechanic 201.

FIG. 3 shows one possible embodiment of using a shared augmented realityenvironment for training, in which a plurality of real participants andreal objects are located in distinct geographic spaces, with the sharedaugmented reality environment populated by virtual avatars of livingbeings and inanimate objects. Specifically, the figure shown representsthe use of the shared augmented reality environment for medical trainingin two locations, depicted here utilizing two panels 311 and 312overlaid over map 320 which depicts distinct training locations 309 and310. Panel 311 represents a view of the training session at location309, and panel 312 represents a view of the training session at location310.

According to this particular embodiment, two human participantsincluding respiratory therapist 304 and nurse 302 are participating in amedical training session concurrently. Participant 302 is located atphysical location 309 and participant 304 is located at physicallocation 310. Both participants 302 and 304 are participating in thesame shared medical training session concurrently, though from differentphysical locations.

Participants 302 and 304 are wearing augmented reality devices 313 and314, respectively. In this embodiment, these devices provide, inaddition to augmented reality projection capability, internetcommunication, sensors, including multiple cameras, IR tracking devices,inertial measurement units, and other sensors, audio speaker systems,and headphones attached to the device in a modular fashion or built intothe device.

Avatars 303 and 306 represent virtual patient avatars which bothrepresent the same simulated patient. The virtual patient is fullysimulated by the system and is interactive with other participants aswell as virtual avatars based upon the instruction set being executed bythe system. Avatar 303 is being projected by device 313 into the view ofparticipant 302, and avatar 306 is being projected by device 314 intothe view of participant 304. Both avatars appear the same and react thesame way, as they are representing the same underlying simulatedpatient. Interactions occurring at either location upon either avatarare reflected by both the avatar at the location where the interactionis physically located as well as the avatar at the other location. Thisis facilitated by internet communication. In this figure, participant304 is preparing to use bag valve mask 315 on avatar 306. The use ofthis tool is detected by sensors on device 314. Device 314 also detectsthe relative spatial position of participant 304 to patient avatar 306.This set of information is then broadcast over the internet, representedby arrow 316, from location 310, to device 313 at location 309. Thistransmission occurs directly between the two devices, or is relayedthrough an internet server, or a series of internet servers and otherdevices, and may first be processed and transformed by a series ofinternet servers and other devices before arriving at its destination.The resulting information is then used by device 313 to project virtualavatar 301, which represents participant 304 and is located at the samelocation relative to virtual patient avatar 303 as the physicalparticipant 304 is relative to virtual patient avatar 306, into thephysical space observed by participant 302.

Similarly, device 313 detects participant 302's location relative topatient avatar 303. This information is transmitted over the internetfrom location 309 to location 310, directly, or via an internet server,or via a series of internet servers and other devices. This informationmay first be processed and transformed by a series of internet serversand other devices before arriving at its destination. The resultinginformation is then used by device 314 to project virtual avatar 305,representing participant 302, into the physical space observed byparticipant 304. This transmission occurs near-instantaneously, allowingfor actions taking by participants 304 or 302 to be observed nearlyimmediately by the other participant, providing the experience that bothparticipants are working in the same space, even though they are locatedin two distinct physical locations that are geographically separated. Inaddition, non-human objects like tools 315 may also be captured andprojected as necessary, so that both participants see the same set ofobjects, either due to the presence of a real object or a virtual avatarrepresenting that real object, such as virtual tool avatar 317.

Also in this particular embodiment, participant 304 is currentlyspeaking speech 308. The audio information comprising this speech isrecorded by the microphone sensor present in device 314. Alternatively,this information could be recorded by any other audio recordingequipment present and connected to the augmented reality system, such asa freestanding microphone with wireless or wired internet connectivity,or a different augmented reality device being worn by a differentparticipant. This information is transmitted from device 314 at location310 to device 313 at location 309. This transmission occurs directlybetween the two devices, or is relayed through an internet server, or aseries of internet servers and other devices, and may first be processedand transformed by a series of internet servers and other devices beforearriving at its destination. Device 313 then uses its headphones tobroadcast the audio information to participant 302. Alternatively, anyother device connected to the augmented reality system with audiospeaker capability could be used to broadcast the audio information,such as a freestanding speaker system with wireless or wiredconnectivity. This gives the appearance of avatar 301 speaking speech307 to participant 302 even though the actual physical speech isoccurring at a different physical location. The content of speech 308 isalso analyzed by device 314 or another device running a simulationexecution application enabling the augmented reality environment, withthat content being recognized as a command to the system or otherrelevant speech, as indicated by the simulation session instruction set.Similarly, other actions by either participant can be recorded by thesystem and transmitted in order to allow the participant at the otherphysical location to experience those actions, such as physicalmovements or interaction with physical objects or virtual avatars. Thisprovides a seamless experience in which participants 302 and 304 appearto experience participating in training at the same location even thoughthey are physically located at two distinct physical locations.

FIG. 4 shows one possible embodiment of using a shared augmented realityenvironment for training. Specifically, the figure shown represents theuse of the shared augmented reality environment for medical training bytwo real human participants, physician 401 and nurse 402. Participants401 and 402 are wearing augmented reality devices 406 and 407respectively, which in this embodiment in addition to possessingaugmented reality projection capability, includes interne communication,sensors, including multiple cameras, wireless beacon tracking sensors,and other sensors, and headphones built into the device or attached in amodular fashion to the device.

According to this particular embodiment, a physical patient dummy 403 isbeing used for the simulation. The physical dummy 403 physicallycontains device 405, which is a combined sensor, wireless receiver, andwireless transmitter, further acting as a trackable wireless beacon forthe dummy 403. Device 405 is able to communicate with augmented realitydevices 406 and 407, which use the information from the device to trackthe relative position of dummy 403 to participants 401 and 402respectively. This allows devices 406 and 407 to project a realisticvirtual patient avatar into the perception of participants 401 and 402over the physical location of dummy 403, providing the illusion that thevirtual patient avatar is in the physical location actually occupied bydummy 403. In addition, devices 406 and 407 transmit the data frombeacon 405 via router 408 to laptop 409 which is running the simulationexecution application with the simulated patient.

Physician 401 is currently using real stethoscope tool 407 on what heperceives to be the virtual patient avatar, which is projected over thereal physical location of dummy 403. Since dummy 403 is in the samelocation, physician 401 receives the tactile sensation caused by thecontact between tool 407 and dummy 403. In addition, device 406 detectsusing its sensors that physician 401 is using stethoscope 407 on thevirtual patient avatar and transmits that information via router 408 tolaptop 409. Device 405 also detects this stethoscope use and transmitsthat data to laptop 409 via router 408. Laptop 409 uses the instructionset for the simulation to determine the appropriate response, which isthen transmitted back to devices 406 and 407 via router 408.

FIG. 5 shows one possible embodiment of using an augmented realityenvironment for training. Specifically, the figure depicts oneparticipant, physician 501 using the augmented reality environment formedical training. In addition, several of the computer systemsfacilitating the augmented reality environment are shown, includingnetwork router 506, laptop computer 507, and server 508. In addition,one possible instruction file 510 for this medical training session isgraphically represented.

Physician 501 is wearing augmented reality device 502 and is located inlocation 509. In this embodiment, in addition to augmented realityprojection capability, device 502 has further capabilities built intothe device or attached to the device in a modular fashion. Specifically,the embodiment shown includes internet communication, sensors, includingmultiple cameras, IR tracking devices, inertial measurement units, andother sensors, audio speaker systems, and headphones. Virtual patientavatar 505 is being projected into the view of physician 501 by device502.

In this particular embodiment, instruction file 510 is the instructionfile for the medical training session that physician 501 is currentlyparticipating in. Instruction file 510 may contain severalsubcomponents, including those four subcomponents depicted, metadata511, instructions 512, access rights 513, and event log 514. Instructionfile 510 was created by an authoring program which generated the filebased on instructions and programming created by the user of theauthoring program.

Metadata 511 includes information about the instruction set, which mayinclude a title, type of simulation, number of participants supported,avatar listing, notes for use by individuals running the simulation, andnotes for participants.

Instructions 512 includes an instruction set which is used by theaugmented reality simulation to control the virtual simulations andavatars and to mediate any interactions in the system. The physicalfeatures of avatar 505 are included in this instruction set. Server 508uses the instructions on these features to generate a three dimensionalvirtual avatar which is then projected by device 502. Actions of theavatar are also governed by these instructions. For example, thebreathing rate of the patient simulation represented by avatar 505 isgoverned by this instruction set. Server 508, running a simulationexecution application, uses these instructions to generate and updatethe breathing rate of the patient representation, which then updates theanimated breathing rate of avatar 505.

Reactions of the avatar to interactions are also specified by theinstruction set. As physician 501 uses stethoscope 504 to auscultatepatient avatar SOS's tricuspid area, this is detected by the augmentedreality device 502 using its sensors, which in this case may include acamera or wireless beacon detector. In this particular embodiment, thisis then transmitted to local internet router 506, which relays theinformation to server 508. Server 508 then uses the instruction setcontained in instructions 512 to determine what the reaction should be.For example, the instruction set may specify that the virtual patientshould gasp as if it were a real patient being exposed to a coldstethoscope head on bare skin. This would then be relayed by server 508via router 506 to device 502, which would update avatar 505 to animateit, with the avatar then gasping. In addition, instruction set 512 mayspecify that the auscultatory heart sound that would be expected from astethoscope placed over the tricuspid area of a real patient should beheard by the participant using the stethoscope, in this case physician501. The appropriate sound file as specified by the instruction setwould be loaded by server 508, and transmitted to device 502 via router506. Device 502 would then use its headphone capability to play thisaudio sound to physician 501. In an alternate embodiment, the sound filewould have been transmitted to device 502 at the beginning of thesession, and then merely locally accessed when its use was triggered. Inaddition, instructions 512 may specify that the heart rate of thevirtual patient simulation should increase when the stethoscope is usedon the patient. Server 508 would then update the heart rate of itsinternal representation of the virtual patient, and transmit a fasterheart sound, as appropriate for the specified heart rate, to be playedby device 502 to physician 501. In addition, any associated display ofthis heart rate, such as a virtual monitor screen, would be updated withthe new heart rate.

When physician 501 first begins to use stethoscope tool 504, device 502may further request information about the tool. This request would berelayed by router 506 to server 508, which would use instructions 512 todetermine the nature of the tool. This would then be transmitted back todevice 502. Device 502 may then further request all associated audiodata in order to cache the data on the device. This request would betransmitted by router 506 to server 508, which would use instructions512 to determine which files are associated with tool 504. Theassociated sound files would then be transmitted by server 508 to device502 in order to reduce future communication time.

Events log 514 contains a log of the events and interactions that occurwithin this particular execution of the simulation, which in thisembodiment is a medical training session. For example, in thisembodiment, physician 501's use of a stethoscope over the tricuspid areaof virtual patient 505, when transmitted to server 508, is logged andappended to file 510 in area 514 along with any associated metadata ofthe action, the time of the action, and any appropriate informationabout the state of the simulation, participants, or virtual avatars ordisplays, as instructed by instructions 512. This will allow server 508to use the fact that this event occurred in calculating furtherevolutions of the state of the simulation if so instructed by theinstruction set. This will also allow users to examine the history ofpast actions that have occurred in this simulation session. In addition,the resulting changes and interactions due to this event as specified byinstructions 512 may also be appended to events log 514 if so instructedby instructions 512. This may also allow for server 508 to create asummary and possible grading of the performance of physician 501 at theconclusion of the training session based on a procedure previouslycreated by the author of the instruction file and contained ininstruction set 512. At the conclusion of the training session, eventslog 514 may be copied and saved to serve as a record of the session, orit may be deleted, or it may be otherwise processed for statisticalpurposes.

In the future, physician 501 may decide after finishing his use ofstethoscope 504 to physically adjust the configuration of bed 503 as amedical intervention using his hands. In this embodiment, this actionwould be detected by the sensors on device 502 or alternatively bysensors or markers on bed 503 or any other external connected sensor,such as a freestanding network enabled camera. This action would betransmitted via router 506 to server 508, where the physician's physicalaction would be recorded in events log 514, and the appropriate responseof the patient simulation would be computed based on instructions 512.The response would then be used to update the patient simulation onserver 508, which would then be used to update the patient avatar. Theupdate would then be transmitted to device 502 via router 506.

In this particular embodiment, the simulation session that physician 501is participating in was previously started by a local training moderatorusing laptop 507. The moderator accessed a listing of available trainingsessions on laptop 507. This request was transmitted via router 506 toserver 508, which produced a listing of available cases. In order todetermine if a case was available for use by the moderator and physician501, server 508 examines the access rights of a particular instructionfile, such as access rights 513 in instruction file 510. Server 508 thencompares the access rights contained in the file to the access that themoderator possesses, and if the moderator's access is sufficient tosatisfy these access rights, the file is included as an available casein the listing sent to the moderator.

In this particular embodiment, the simulation session that physician 501is participating in is being concurrently broadcast to laptop 507 forviewing by the training moderator. The training moderator is able to seethe scene as seen by physician 501 due to device 502 sensing the sceneusing its sensors and broadcasting them via router 506 to server 508. Inanother embodiment, a distinct camera may be present in the physicaltraining environment, with that camera's audio and video data beingtransmitted via router 506 to server 508. Server 508 then rebroadcaststhe scene to laptop 507. In addition, this video information may beappended to events log 514 by server 508 as a record of physician 501'sperspective during the training session if so desired. In other possibleembodiments, server 508 and laptop 507 may be the same computing deviceor different computing devices, or a set of computing devices, which maybe located in the same location as the participants of the simulation,or in a different location, or in multiple different locations, ordistributed using cloud computing. The instruction moderator may bedistinct from the participants, or it may be one of the participants, orthere may be no moderator. The moderator may be located at the samelocation as the participants of the simulation, or could be in a remotelocation. There may be one moderator, multiple moderators, or nomoderators. In this scene, the moderator using laptop 507 is also ableto make modifications to the current session. For example, the moderatormay decide to add an additional sudden medical complication to thetraining session. This would be entered into laptop 507 and transmittedvia router 506 to server 508. Server 508 would use this input incombination with instructions 512 to determine what changes to make toits internal patient representation. These changes would then be used toupdate the patient avatar and any other virtual avatars or virtualscreens, and the results would then be broadcast via router 506 todevice 502 and then projected into the view of physician 501.

FIG. 6 shows one possible embodiment of the infrastructure supportingaccess to instruction files and associated data by components of theaugmented reality environment, including both servers, clients, andother associated computing devices. Two different scenarios aredepicted, scenarios 601 and 602.

In the particular embodiment of scenario 601, request 603, which is arequest for an instruction file or associated data, such as audiorecordings, graphical models, or sub-instruction sets, is transmittedfrom a client, such as an augmented reality device, a computing devicebeing used by a moderator, or a simulation server, to local router 604.Router 604 then transmits the request as request 605 to local databaseserver 606. In other embodiments, the local database server may be thesame computing device as any other device used in the simulation system,such as a moderator client device, or a simulation server, or it may bea distinct computing device, or there may be no local database server.Local database 606 then uses request 605 to search its local datastoreand finds the data requested. This data is packaged and transmitted asresponse 607 to local router 604, which then transmits it as response608 to the requesting computing device. In other embodiments, there maybe additional routers or other networking appliances involved in thecommunication chain, or the requesting device may be directly networkedwith the local database server, local database server and the requestingapplication may be different processes running on the same computingdevice.

In the particular embodiment of scenario 602, request 609 is also arequest for an instruction file or associated data. This request istransmitted to local router 610, which then transmits it as request 611to local database server 612. Server 612 uses request 611 to search itslocal datastore, but does not find the data requested. Server 612 thensends request 613 for the data to router 610, which then transmits itvia the internet to simulation distribution infrastructure 615 asrequest 614. This infrastructure may consist of one or more remotecomputing servers or a cloud computing infrastructure. Infrastructure615 locates the data request on server 616 and transmits request 617.Server 616 then uses request 617 to search its local datastore andretrieve the requested data, which is then transmitted to infrastructure615 as response 618. Infrastructure 615 then retransmits the receiveddata as response 619 to router 610, which transmits it as response 620to local database server 612. Local database server may cache theresulting response data in its local datastore and then retransmits thedata as response 621 to local router 610, which retransmits the data asresponse 622 to the requesting computing device. In other embodiments,multiple routers or other networking appliances may be used in thetransmission and retransmission of requests or responses. In otherembodiments, server 616 may be a part of infrastructure 615 or may be astandalone server. In other embodiments, local database server 612 mayconsist of multiple computing devices, all of which search for the datalocally before making a request to infrastructure 615, or there may beno local database server at all, in which case the requesting devicewould transmit request 609 directly to infrastructure 615 via router610. In other embodiments, response 622 may be processed by therequesting device and as a result additional data may be requested viathe same process as request 609. In other embodiments, the request datamay be available via an online marketplace accessible via infrastructure615, in which case information about the data available would betransmitted back to the requestor which would then decide whether or notto purchase the requested data. In one possible such embodiment, theoriginal author of the instruction set or other content may store thiscontent on a local server, such as server 616, and infrastructure 615would mediate the request for the data by the original server 612, andif a purchase is made, mediate the transfer of valuable considerationfrom the operators of server 612 to the operators of server 616, and thetransfer of the purchased data from server 616 to server 612. Inaddition, infrastructure 615 may mediate the return of required data,such as metadata regarding use of the content, to server 616. Server 612may be disallowed from saving the requested content locally, thusrequiring a check to be made via infrastructure 615 to ensure that theoperators of server 612 continue to have licensing rights to thepurchased content and mediating any additional licensing purchases asnecessary.

FIG. 7 shows one possible embodiment of an authoring program forinstruction sets used by the augmented reality simulation system. Inthis embodiment, an author is creating an instruction set for use in amedical training simulation.

In this particular embodiment, a set of states 701 comprising theinstruction set has been created by the author. The author is currentlyediting one particular state 703, some of the parameters for which aredisplayed on the editing panel 702. The author is able to configureglobal physical parameters for case, such as the patient's gender 704,ethnicity 705, and age 706 for a virtual patient as may be appropriatein a medical training application of the augmented reality system. Inaddition, parameters specific to the selected state 703 areconfigurable, including the physiological variables heart rate 707,blood pressure 708, oxygenation 709 and temperature 710. Additionalparameter may also be available to be configured for each state. Theseparameters could be the same for multiple states, or could be differentper state. In addition, free text notes such as 714 may be appended to astate for use by an instruction moderator or participant.

The set of states 701 also includes conditions, such as condition 711.These conditions govern transitions of the simulation from one state toanother state. Conditions are also configured by the instruction setauthor, and could involve any aspect of the simulation, such as thepassage of time, interactions by participants and virtual avatars,interactions between virtual avatars, use of real or virtual tools, orany other event in the simulation environment. Conditions may becomprised of a single item or any Boolean configuration of items. Whenconditions are met, they may cause the transition of the simulation fromone state to another state. For example, satisfying condition 711 maycause the simulation state to transition from state 703 to state 715,leading in this example to a change of the physiological characteristicssuch as the heart rate of the virtual patient with appropriate physicaland interactive signs displayed by the virtual avatar representing thepatient and on the virtual cardiac monitor displayed in the augmentedreality environment.

One state in the set of states 701 may represent an end state or goalstate. In this embodiment, state 712 is a goal state defined by theinstruction set author. One or more participants in the simulationencoded by the instruction set may be graded based on whether or notthis goal state is achieved during the course of the simulation. Inaddition, failure states can also be added to the set of states which,if reached, end the simulation or rewind the simulation to an earlierstate. At the termination of a simulation, the contributions made byindividual participants as well as the summated group performance inprogressing through the states of the simulation may be used to providefeedback or grading of performance. In addition, factors such as thelength of time required to progress between states, incorrect orirrelevant actions or interactions, communications between participantsor between participants and virtual avatars, and other events that occurduring the course of the simulation may be used in grading and feedback.The procedure for performing this grading and feedback as well as thefactors to be considered are part of the instruction set authored by theauthor using the authoring program. Grading and feedback may be providedto participants directly through the augmented reality system, or aprinted or electronic report may be provided. Grading and feedback maybe recorded permanently and stored, or it may be deleted, or statisticsmay be compiled and transmitted to a database for storage and futureevaluation. Grading and feedback may be provided for the entire group oron an individual basis to participants.

Instruction set authors may also load other instruction sets, such as byusing a load command 713, in order to include other instruction setswithin the instruction set being authored, allowing for the reuse orediting of common components or a modular instruction structure. Otherdata components, such as tool definitions, audio data, or graphicsmodels, may also be loaded into an instruction set. Components may beloaded from instruction sets located on the authoring device, or from anexternal piece of computer readable media, or from the internet.Components may also be accessible through a marketplace, and authors maybe able to purchase reusable components for use within their instructionsets. Loaded components may be integrated into a set of states or otherinstruction set and may be used in conjunction with newly definedinstructions or states.

Instruction sets can be saved locally using a save command 716 allowingfor use of the instruction set for simulation session. In addition,instruction sets may be uploaded to a local database server or to aninternet storage database for distribution. This database may be part ofan instruction set marketplace, and other users may then be able topurchase licenses for use of the instruction set, potentially includinguse for simulation execution or use as subcomponents for instruction setauthoring. Fees may be charged on a per instruction set, per use, or perparticipant basis. Statistics on the use of the instruction set may becollected and transmitted back to the author for use in futuredevelopment or for tracking.

FIG. 8 shows one possible embodiment of an authoring program forinstruction sets used by the augmented reality simulation system. Inthis embodiment, an author is creating an instruction set for use in amedical training simulation.

In this particular embodiment, the author is designing an instructionset for a particular tool, bag valve mask 801. The authoring programallows the specification of the appearance of the tool as well as itscharacteristics. In this example, the tool is used by participants onthe virtual patient avatar, and the author is configuring the effects ofthe tool on the patient simulation. This includes the characteristic 802that the tool affects, the direction 803 of the effect, the magnitude804 of the effect, and the valid target 805 of the tool.

The instruction set can be saved using a save command 806. Saved toolinstruction sets can then be loaded into other instruction sets for usein creating a simulation instruction set. The set can be saved locally,on a local database server, or it to an interne storage database fordistribution. This database may be part of an instruction setmarketplace, and other users may then be able to purchase licenses foruse of the instruction set.

According to one embodiment, the techniques described herein areimplemented by one or more special-purpose computing devices. Thespecial-purpose computing devices may be hard-wired to perform thetechniques, or may include digital electronic devices such as one ormore application-specific integrated circuits (ASICs) or fieldprogrammable gate arrays (FPGAs) that are persistently programmed toperform the techniques, or may include one or more general purposehardware processors programmed to perform the techniques pursuant toprogram instructions in firmware, memory, other storage, or acombination. Such special-purpose computing devices may also combinecustom hard-wired logic, ASICs, or FPGAs with custom programming toaccomplish the techniques. The special-purpose computing devices may bedesktop computer systems, portable computer systems, handheld devices,networking devices or any other device that incorporates hard-wiredand/or program logic to implement the techniques.

FIG. 9 is a block diagram that illustrates a computer system 900 uponwhich an embodiment of the invention may be implemented. Computer system900 includes a bus 902 or other communication mechanism forcommunicating information, and a hardware processor 904 coupled with bus902 for processing information. Hardware processor 904 may be, forexample, a general purpose microprocessor.

Computer system 900 also includes a main memory 906, such as a randomaccess memory (RAM) or other dynamic storage device, coupled to bus 902for storing information and instructions to be executed by processor904. Main memory 906 also may be used for storing temporary variables orother intermediate information during execution of instructions to beexecuted by processor 904. Such instructions, when stored innon-transitory storage media accessible to processor 904, rendercomputer system 900 into a special-purpose machine that is customized toperform the operations specified in the instructions.

Computer system 900 further includes a read only memory (ROM) 908 orother static storage device coupled to bus 902 for storing staticinformation and instructions for processor 904. A storage device 910,such as a magnetic disk, optical disk, or solid-state drive is providedand coupled to bus 902 for storing information and instructions.

Computer system 900 may be coupled via bus 902 to a display 912, such asa cathode ray tube (CRT), for displaying information to a computer user.An input device 914, including alphanumeric and other keys, is coupledto bus 902 for communicating information and command selections toprocessor 904. Another type of user input device is cursor control 916,such as a mouse, a trackball, or cursor direction keys for communicatingdirection information and command selections to processor 904 and forcontrolling cursor movement on display 912. This input device typicallyhas two degrees of freedom in two axes, a first axis (e.g., x) and asecond axis (e.g., y), that allows the device to specify positions in aplane.

Computer system 900 may implement the techniques described herein usingcustomized hard-wired logic, one or more ASICs or FPGAs, firmware and/orprogram logic which in combination with the computer system causes orprograms computer system 900 to be a special-purpose machine. Accordingto one embodiment, the techniques herein are performed by computersystem 900 in response to processor 904 executing one or more sequencesof one or more instructions contained in main memory 906. Suchinstructions may be read into main memory 906 from another storagemedium, such as storage device 910. Execution of the sequences ofinstructions contained in main memory 906 causes processor 904 toperform the process steps described herein. In alternative embodiments,hard-wired circuitry may be used in place of or in combination withsoftware instructions.

The term “storage media” as used herein refers to any non-transitorymedia that store data and/or instructions that cause a machine tooperate in a specific fashion. Such storage media may comprisenon-volatile media and/or volatile media. Non-volatile media includes,for example, optical disks, magnetic disks, or solid-state drives, suchas storage device 910. Volatile media includes dynamic memory, such asmain memory 906. Common forms of storage media include, for example, afloppy disk, a flexible disk, hard disk, solid-state drive, magnetictape, or any other magnetic data storage medium, a CD-ROM, any otheroptical data storage medium, any physical medium with patterns of holes,a RAM, a PROM, and EPROM, a FLASH-EPROM, NVRAM, any other memory chip orcartridge.

Storage media is distinct from but may be used in conjunction withtransmission media. Transmission media participates in transferringinformation between storage media. For example, transmission mediaincludes coaxial cables, copper wire and fiber optics, including thewires that comprise bus 902. Transmission media can also take the formof acoustic or light waves, such as those generated during radio-waveand infra-red data communications.

Various forms of media may be involved in carrying one or more sequencesof one or more instructions to processor 904 for execution. For example,the instructions may initially be carried on a magnetic disk orsolid-state drive of a remote computer. The remote computer can load theinstructions into its dynamic memory and send the instructions over atelephone line using a modem. A modem local to computer system 900 canreceive the data on the telephone line and use an infra-red transmitterto convert the data to an infra-red signal. An infra-red detector canreceive the data carried in the infra-red signal and appropriatecircuitry can place the data on bus 902. Bus 902 carries the data tomain memory 906, from which processor 904 retrieves and executes theinstructions. The instructions received by main memory 906 mayoptionally be stored on storage device 910 either before or afterexecution by processor 904.

Computer system 900 also includes a communication interface 918 coupledto bus 902. Communication interface 918 provides a two-way datacommunication coupling to a network link 920 that is connected to alocal network 922. For example, communication interface 918 may be anintegrated services digital network (ISDN) card, cable modem, satellitemodem, or a modem to provide a data communication connection to acorresponding type of telephone line. As another example, communicationinterface 918 may be a local area network (LAN) card to provide a datacommunication connection to a compatible LAN. Wireless links may also beimplemented. In any such implementation, communication interface 918sends and receives electrical, electromagnetic or optical signals thatcarry digital data streams representing various types of information.

Network link 920 typically provides data communication through one ormore networks to other data devices. For example, network link 920 mayprovide a connection through local network 922 to a host computer 924 orto data equipment operated by an Internet Service Provider (ISP) 926.ISP 926 in turn provides data communication services through the worldwide packet data communication network now commonly referred to as the“Internet” 928. Local network 922 and Internet 928 both use electrical,electromagnetic or optical signals that carry digital data streams. Thesignals through the various networks and the signals on network link 920and through communication interface 918, which carry the digital data toand from computer system 900, are example forms of transmission media.

Computer system 900 can send messages and receive data, includingprogram code, through the network(s), network link 920 and communicationinterface 918. In the Internet example, a server 930 might transmit arequested code for an application program through Internet 928, ISP 926,local network 922 and communication interface 918.

The received code may be executed by processor 904 as it is received,and/or stored in storage device 910, or other non-volatile storage forlater execution.

In the foregoing specification, embodiments of the invention have beendescribed with reference to numerous specific details that may vary fromimplementation to implementation. The specification and drawings are,accordingly, to be regarded in an illustrative rather than a restrictivesense. The sole and exclusive indicator of the scope of the invention,and what is intended by the applicants to be the scope of the invention,is the literal and equivalent scope of the set of claims that issue fromthis application, in the specific form in which such claims issue,including any subsequent correction.

What is claimed is:
 1. A method comprising: receiving, by an authoringapplication running on a computing device, a set of one or more valuesthat define at least one of a physical or a physiological property of avirtual avatar; in response to receiving the set of one more values,generating, by the authoring application running on the computingdevice, an instruction set for virtual avatar projection into anaugmented or virtual reality environment; wherein the instruction setincludes instructions used by an augmented or virtual realityapplication to project the virtual avatar into real or virtual spacesuch that the virtual avatar exhibits a behavior based, at least inpart, on at least one of the physical or the physiological propertiesdefined through the authoring application; executing the instruction setby the augmented or virtual reality application for a plurality ofaugmented or virtual reality devices, wherein each respective augmentedor virtual reality device of the plurality of augmented or virtualreality devices concurrently projects a respective view from a differentangle of the virtual avatar exhibiting the behavior based on a physicallocation of the respective augmented or virtual reality device;detecting, by a wireless sensor of at least one of the augmented orvirtual reality devices of the plurality of virtual reality devices, aninteraction between a medical tool that is or virtually present in thereal or virtual space and the virtual avatar; simulating, within therespective view for each respective augmented or virtual reality device,a physiological response based at least in part on a type of medicaltool being used in the interaction and at least one of the physical orthe physiological properties defined through the authoring application.2. The method according to claim 1, wherein the instruction setgenerated by the authoring application is operable to trigger changes tothe augmented or virtual reality environment over time or based upon apassage of time, such that a sequence of events occurs in the augmentedor virtual reality environment as defined by the instruction set.
 3. Themethod according to claim 2, wherein a sequence of events occurring overtime and defined by an instruction set is operable to be navigated bypausing execution, reversing execution, accelerating execution, movingto any time point in the instruction set and starting execution fromthat point, resuming execution, or stopping execution for allparticipants sharing the augmented or virtual reality environment. 4.The method according to claim 1, wherein generating the instruction setcomprises selecting from a set of predefined instructions, composing newinstructions, or uploading instructions from an external piece ofnon-transitory computer readable media.
 5. The method according to claim1, wherein the authoring application allows for an author to allow atleast one characteristic of at least one virtual avatar to change inresponse to any change in the augmented or virtual reality environment.6. The method according to claim 1, wherein the instruction setgenerated by the authoring application is distributed to other users viaan online marketplace, allowing for control of access to the instructionset, charging of fees for the instruction set, or collection of dataregarding usage of the instruction set.
 7. The method according to claim1, wherein the instruction set generated by the authoring applicationcauses the behavior is a physiological reaction that is exhibitedresponsive to interactions taken by a participant of the augmented orvirtual reality environment during simulation of a medical procedure. 8.The method of claim 1, wherein the augmented or virtual realityapplication broadcasts, via a router, information for projecting viewsof the virtual avatar to the plurality of augmented or virtual realitydevices based on respective physical locations of the plurality ofaugmented or virtual reality devices.
 9. The method of claim 8, whereinat least two of the plurality of augmented or virtual reality devicesare being used at different physical locations but allow users to walkaround and interact with projections of the virtual avatar as ifoccupying a shared physical space.
 10. The method of claim 1, whereinthe instructions further cause operations comprising: receiving, by theaugmented or virtual reality application from a moderator, amodification to a current medical state of the virtual avatar;responsive to receiving the modification, updating views of the virtualavatar that are projected by the plurality of augmented or virtualreality devices.
 11. One or more non-transitory computer-readable mediastoring instructions which, when executed by one or more computingdevices, causes operations comprising: receiving, by an authoringapplication running on a computing device, a set of one or more valuesthat define at least one of a physical or a physiological property of avirtual avatar; in response to receiving the set of one more values,generating, by the authoring application running on the computingdevice, an instruction set for virtual avatar projection into anaugmented or virtual reality environment; wherein the instruction setincludes instructions used by an augmented or virtual realityapplication to project the virtual avatar into real or virtual spacesuch that the virtual avatar exhibits a behavior based, at least inpart, on at least one of the physical or the physiological propertiesdefined through the authoring application; executing the instruction setby the augmented or virtual reality application for a plurality ofaugmented or virtual reality devices, wherein each respective augmentedor virtual reality device of the plurality of augmented or virtualreality devices concurrently projects a respective view from a differentangle of the virtual avatar exhibiting the behavior based on a physicallocation of the respective augmented or virtual reality device;detecting, by a wireless sensor of at least one of the augmented orvirtual reality devices of the plurality of virtual reality devices, aninteraction between a medical tool that is present in the real orvirtual space and the virtual avatar; simulating, within the respectiveview for each respective augmented or virtual reality device, aphysiological response based at least in part on a type of medical toolbeing used in the interaction and at least one of the physical or thephysiological properties defined through the authoring application. 12.The one or more non-transitory computer-readable media of claim 11,wherein the instruction set generated by the authoring application isoperable to trigger changes to the augmented or virtual realityenvironment over time or based upon a passage of time, such that asequence of events occurs in the augmented or virtual realityenvironment as defined by the instruction set.
 13. The one or morenon-transitory computer-readable media of claim 12, wherein a sequenceof events occurring over time and defined by an instruction set isoperable to be navigated by pausing execution, reversing execution,accelerating execution, moving to any time point in the instruction setand starting execution from that point, resuming execution, or stoppingexecution for all participants sharing the augmented or virtual realityenvironment.
 14. The one or more non-transitory computer-readable mediaof claim 11, wherein generating the instruction set comprises selectingfrom a set of predefined instructions, composing new instructions, oruploading instructions from an external piece of non-transitory computerreadable media.
 15. The one or more non-transitory computer-readablemedia of claim 11, wherein the authoring application allows for anauthor to allow at least one characteristic of at least one virtualavatar to change in response to any change in the augmented or virtualreality environment.
 16. The one or more non-transitorycomputer-readable media of claim 11, wherein the instruction setgenerated by the authoring application can be is distributed to otherusers via an online marketplace, allowing for control of access to theinstruction set, charging of fees for the instruction set, or collectionof data regarding usage of the instruction set.
 17. The one or morenon-transitory computer-readable media of claim 11, wherein theinstruction set generated by the authoring application causes thebehavior is a physiological reaction that is exhibited responsive tointeractions taken by a participant of the augmented or virtual realityenvironment during simulation of a medical procedure.
 18. The one ormore non-transitory computer-readable media of claim 11, wherein theaugmented or virtual reality application broadcasts, via a router,information for projecting views of the virtual avatar to the pluralityof augmented or virtual reality devices based on respective physicallocations of the plurality of augmented or virtual reality devices. 19.The one or more non-transitory computer-readable media of claim 18,wherein at least two of the plurality of augmented or virtual realitydevices are being used at different physical locations but allow usersto walk around and interact with projections of the virtual avatar as ifoccupying a shared physical space.
 20. The one or more non-transitorycomputer-readable media of claim 11, wherein the instructions furthercause operations comprising: receiving, by the augmented or virtualreality application from a moderator a modification to a current medicalstate of the virtual avatar; responsive to receiving the modification,updating views of the virtual avatar that are projected by the pluralityof augmented or virtual reality devices.